Eigenschaften von integrierten Versorgungs­programmen und deren Einfluss auf den Patientennutzen: Ein Discrete-Choice Experiment für Versorgungsnetzwerke

Zusammenfassung

Ziel: Innovative Versorgungsmodelle sollen die Reibungsverluste in der Versorgung minimieren. Die erfolgreiche Umsetzung von Versorgungsnetzwerken setzt voraus, dass diese von den Versicherten und Bürgern akzeptiert werden. Die Berücksichtigung der Präferenzen bei der Umsetzung ist ein wesentlicher Erfolgsfaktor. Ziel dieser Studie ist die Analyse von Patientenpräferenzen.

Methode: Mithilfe von Discrete-Choice Experimenten wurden 21 patientenrelevante Attribute von innovativen Versorgungsprogrammen untersucht. Auf der Basis „Balanced Overlapping Designs“ (Sawtooth) konnten insgesamt 140 Choice-Sets mit höchstmöglicher D-Effizienz generiert werden. Die 21 Attribute wurden zur Abfrage in 4 thematische Schwerpunkte unterteilt. Das Kostenattribut wurde als einheitlicher Komparator integriert. Die Auswertung erfolgte durch Random-Effects Logit Schätzung (STATA).

Ergebnisse: Die repräsentative Stichprobe (N=1 322) ergab, dass in allen 4 DCE-Blöcken das Attribut „Zusätzliche Kosten“ den stärksten Einfluss auf die Wahlentscheidung der Patienten (1: Koef.: 1,047; 2: Koef.: 1,105; 3: Koef.: 0,956; 4: Koef.: 0,954) hat. Es folgten: „Medizinische Geräte und Einrichtung“, „Wartezeit auf einen Termin“, „Berufserfahrung“, „Fahrzeit zur Behandlung“ und „Austausch klinischer Informationen“. Einen geringen Einfluss auf die Wahlentscheidungen hatten z. B. „Überleitungsmanagement“ und „Berücksichtigung der individuellen Lebensbedingungen“.

Schlussfolgerung: Um die Akzeptanz von innovativen Versorgungsprogrammen zu erhöhen, müssen die Präferenzen bekannt sein bzw. in das Design der Dienstleistungen integriert werden. Die vorliegende Studie versucht, die Perspektive von Patienten auf neue Versorgungssysteme abzubilden. Die Auswahlentscheidungen werden nicht wie erwartet durch innovative Ansätze wie das Fallmanagement oder die partizipative Entscheidungsfindung beeinflusst, sondern vielmehr durch die Qualität der Infrastruktur, die Wartezeit und Berufserfahrung.

Abstract

Purpose: Innovative care models shall reduce the frictional losses in health-care. The successful implementation of care networks requires the acceptance by the health care providers, by the patients and citizens as well as by the payers. The consideration of preferences is an essential factor for success. The aim of this study is to analyse patient preferences.

Methods: With the help of Discrete-Choice experiment 21 patient-relevant attributes of innovative healthcare programmes were examined. On the basis of a balanced overlapping design (sawtooth) a total of 140 choice sets with the highest possible D efficiency was generated. The 21 attributes were divided into 4 thematic priorities for analysis. The cost attribute was integrated as a uniform comparator. The evaluation was done by a random effects logit estimation (STATA).

Results: The representative samples (N=1 322) revealed that in all 4 DCE blocks the attribute “additional costs” had the strongest influence on the patients choice (1: coeff.; 1.047; 2: coeff.: 1.105; 3.: coeff.: 0.956; 4.: coeff.: 0.954). This was followed by “medical apparatus and facilities”, “waiting time for an appointment”, “professional experience”, “travelling time to treatment site”, and “exchange of clinical information”. “Transfer management” and “consideration of individual circumstances” for example, had a small influence on patient choice.

Conclusion: In order to increase the acceptance of innovative health-care programmes preferences must be known and integrated into the design of the services. The present study has attempted to depict the patients’ perspectives towards the new care systems. The individual selection decisions were not, as would be expected, influenced by the innovative approaches such as case management or shared decision making but rather by the quality of the infrastructure, the waiting times and professional experience.

Schlüsselwörter

Patientenpräferenzen - Discrete-Choice Experimente­ - integrierte Versorgung - Versorgungsnetzwerke

Key words

patient preferences - discrete-choice experiment - integrated care - healthcare network

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